 |
Men's Health Promotion in General Practice. A
project of the North East Valley, Northern & Melbourne Divisions of
General Practice. |
This program used an organisational development approach to improve systems and processes within the practice, on which health promotion systems could be built. It emphasised strongly the need for upskilling within the practice, directed change at the decision-makers in the organisation (financial partners) and aimed continually for sustainable change, upskilling GPs and staff to make the changes themselves. One of the most distinguishing features of this model is its emphasis on separating the roles of manager and clinician for General Practitioners.
This model utilised a practice-centred approach where it was completely versatile to the vision that the Management Team saw for the Practice and too in its expectations of the appropriate process to get there, and sensitive to the timing they felt comfortable with. Although the key changes were those espoused by the RACGP's Putting Prevention into Practice, an extensive and slow awareness-raising component was included for the main part of the project. Activities within the Practice Support model such as completing the RACGP's needs assessment and conducting a patient survey, were not so much only to collect information, but to widen the GP's awareness of the possibilities for health promotion in general practice.
The practice support culminates, to some extent, in the development of a practice specific Health Promotion Plan. The plans include specific points GPs had highlighted as important either through the Needs Assessment, the patient survey, and/or the GP Visit/Resource kit. It is a working document that records who is responsible for tasks and the agreed timeline and priorities of tasks.
The emphasis on encouraging the GP's role as a manager - and a manager of systems, was crucial in the leadership required to gear their staff towards involvement and commitment to changing the culture within their practice.
Although this model is quite resource intensive it had success in assisting practices to make a substantial shift in the way their practice was organised for health promotion, especially men's health promotion. The Final Evaluation will be available on this website in September.
Step- by- step
Guide
1.
Establish contact with key GP. (Consider an appropriate recruitment strategy
that suits your division and the program area of health promotion you want to
implement)
2. Meet
with key GP and provide an overview of project with particular attention to:
-
The organisational approach this program uses
-
Discuss the importance of a “whole of practice” organisational approach.
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Gain commitment for him/her to discuss practice’s potential involvement in these programs with Business Partners.
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Provide introductory information on the project (see Appendix A for an example)
3. Meet
with all Business Partners (together) to provide an overview of project
with particular attention to:
-
The organisational approach this program uses (as outlined to the Key GP previously)
-
The level of commitment required
-
Gain agreement and commitment to participate.
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Ensure Business Partners inform other GPs and Practice staff of program.
4. Meet
with all Business Partners and the Practice Manager (Practice Management
Team). (Provide an agenda for the next few meetings [Appendix B].)
-
Identify areas of health promotion that are working well in the practice
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Identify areas the management team would like to improve
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Complete the RACGP’s Putting Prevention into Practice Practice Prevention Inventory (Needs Assessment see link)
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Discuss what they consider would be the most appropriate next step.
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Suggest the benefits of conducting a short survey of their patients to assess what their expectations and needs are regarding health promotion.
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Provide a copy of the RACGP’s Putting Prevention into Practice and a magazine holder for all project information.
5. Meet
with Practice Management Team to agree on appropriate survey questions and
methodology
(eg. how many surveys? who will be
asked? who will dispense the survey? when will it be done? etc) [A survey and
data entry program are available from http://www.nevdgp.org.au]
6. Provide
proforma for survey and assist Practice staff to plan systems for
-
distributing (eg. as patients come in),
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collecting (eg. providing a shoe box on reception desk) and
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storing the surveys (eg. empty shoebox at lunchtime and at the end of day, store in a manila folder in Practice Manager’s room.)
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Provide ongoing telephone support and visit staff to develop relationships and encourage continuity.
7. Install Excel
Program to enter survey data. Explain program to Practice Manager (and/or other
relevant staff). Assist Practice Manager to screen survey results and adjust for
abnormalities using a systematic approach and reasoning through assumptions.
8.
Assist Practice Manager to analyse results and create a report.
9.
Meet with Practice Management Team to REVIEW.
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Discuss results from survey and
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Review results from Needs Assessment.
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Provide copies of the summary of the RACGP’s Putting Prevention into Practice.
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Discuss what they consider to be the most appropriate next step.
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Suggest the GP Visitation program or Resource kit. (Explain it is aimed more at what happens at the consultation level, but may be useful in providing new ideas to include in the Health Promotion Plan at the practice level as well.)
[GP
Visitation Program/Resource kit]
Meet
with GPs to discuss the Resource kit and the issues to do with Men’s Health.
(The GP Visitors Program was a peer education, academic detailing program using
the Resource kit - also available on this website. This is the only stage in
this program where the GP is encouraged to considers men’s health and health
promotion specifically from a clinician’s, rather than a manager’s, point of
view. Ensure the GP is aware of his/her change of role)
10. Meet with Practice
Management team to draft a Practice Health Promotion Plan.
-
Use the results from the Needs Assessment and the survey.
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Include any relevant (whole of practice based) ideas raised from the GP Visit.
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Use the summary of Putting Prevention into Practice for ideas.
11. Meet with Practice
Management Team to review draft of Practice Health Promotion Plan. Agree
on. (Health Promotion Plans are also available on this website.)
-
On agreement, encourage the Management Team to appoint a new Health Promotion Coordinator at the time of the meeting. Project Officer should then hand responsibility over to the HP Coordinator for now coordinating the implementation of the Plan. Assure the team the Project Officer is still available for support but that the Plan will now be internally driven.
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Establish a system of periodic review for Management Team to monitor progress of the new plan and address any barriers.
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Ensure actions have been planned to appropriately engage entire practice personnel in appropriate implementation of the plan.
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Encourage the use of the tool to assist with each “action step”
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Encourage the use of the two resources cross-referenced to provide additional support
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Ensure them of availability to visit the practice and provide any additional support required.
12. Meet with Management
Team to review (approximately first two reviews). Assist Management Team to
review progress on Health Promotion Plan and revise action plans accordingly.
13. Provide any appropriate
assistance required in the implementation of the Plan. Provide regular phone
support and encourage the smallest of changes. Remind staff that this sort of
change is a slow process and reassure them of the work they have already
achieved.
14. Withdraw from Practice.
Appendix A - Introductory information on the overall project and this program in particular
Click here for 1 page flowchart (pdf)
Appendix
B
1.
Identify what is working well in the Practice
2.
Identify areas management would like to improve
3.
Complete the RACGP’s Practice Prevention Inventory
4.
Understand the structure of the organisation – the different relationships
between different positions
5.
Identify systems of communication within the organisation
ACKNOWLEDGEMENT
This project has been funded
by the Commonwealth Department of Health and Aged Care within the Divisions of
General Practice Program, under the Innovative Projects scheme. The project
began in September of 1999 and is due to finish in August of this year.
The overall aim of the
project is “to facilitate the reorientation of General Practitioners towards
cost-effective, evidence-based health promotion in general practice settings by
implementing RACGP guidelines in the context of Men’s Health Promotion.”
There are many strategies and activities planned to meet this aim and they are
aimed at two different levels: the practice and the consultation.
Practice level – Practice
Support
The main activity aimed at
the Practice level is Practice Support. This will involve only ten
selected practices. This activity is intensive and generally aimed to provide a
“whole of practice” approach to health promotion. Practice support aims to
assist GPs to develop a Health Promotion Plan according to RACGP guidelines (and
this includes an arm of men’s health promotion) and then to assist practice
staff in implementing the health promotion plan, developing sustainable systems.
Practice Support involves
regular visits over several months. Initially it is important to meet with the
management team to discuss the future direction of the practice, its mission
statement and goals, especially in regards to health promotion.
Consultation level – GP
Visits
The main activity aimed at
the consultation level is GP Visits. GP Visitors will assist their GP colleagues
who are participating in the Practice Support activity by encouraging them to
adopt Men’s Health Promotion principles within consultations. (This is based
on a similar idea to how Divisions have assisted GPs in the area of
Immunisation.) The visits will last approximately half an hour. The Project
Coordinator will arrange the visits and also be present during them.
The visits will provide an
opportunity for GPs to discuss any issues to do with health promotion and/or
men’s health, with a like-minded GP. They will provide the opportunity for GPs
to identify any barriers and find solutions for GPs practicing men’s health
promotion.
A Resource Kit will also be
supplied for GPs.
In summary the
Men’s Health Promotion in General Practice project aims to assist practices
and GPs, systematically practice health promotion with an emphasis on Men’s
Health Promotion. The project aims to assist GPs and Practices in such a way as
to produce sustainable change in these areas.